The goal of this project is to develop and implement close-call reporting systems in clinical units of three hospitals, analyze the frequencies of close calls and identify underlying causes, and develop a series of quality improvement (QI) projects to reduce close calls and system failures in those units. Drawing on the strengths of this center for patient safety, we will also integrate lessons learned from other center projects. These include understanding the cognitive science of error (project 1, Zhang); and surveys used to assess organizational culture (project 4, Helmreich). This project will also rely upon Dr. Helmreich?s experience in designing a near-miss reporting system for aviation (Aviation Safety Action Partnership, ASAP) and the extensive experience of the Performance Improvement Department of MD Anderson Cancer Center, which will lead the project. This project?s specific aims are to: 1) Design and implement a close-call reporting system at each study site, using clinical ("front-line") staff (physicians, nurses, pharmacists) to inform the process; and 2) Design and implement quality improvement projects to reduce error based on analysis of reported close calls, and assess the results of the QI projects in addressing the close calls.